The care of nursing home residents with moderate to severe cognitive impairment has traditionally followed a custodial approach where nursing staff focus on minimizing behavioral problems and perform necessary functional tasks for these individuals during care activities. While unintended, resistance to care, functional decline, medical complications of immobility, and overuse of psychotropic medications and adverse events, such as falls, are more likely to occur with custodial care practices. Therefore, it is critical to implement non-pharmacological interventions to minimize behavioral disturbance, optimize physical function, and decrease the risk of adverse events among nursing residents with moderate to severe cognitive impairement.To address these challenges, the proposed study will test the effectiveness of the Function and Behavior Focused Care for the Cognitively Impaired (FBFC-CI) Intervention. FBFC-CI is based on a socioecological model and is designed to change nursing staff behavior by motivating and teaching them skills to decrease behavioral symptoms and optimize function and physical activity among nursing home residents with dementia. The aims of this study are to test the impact of FBFC-CI on both behavioral and functional outcomes of residents with moderate to severe cognitive impairment and explore the adoption of the intervention at the facility level. Specifically, we will implement FBFC-CI in a cluster randomized trial of 480 residents in twelve nursing homes (40 residents per nursing home) to accomplish the following aims: Aim 1. Evaluate the effectiveness of FBFC-CI on behavioral symptoms (depression, resistance to care, agitation), psychotropic medication use, function (ADLs, performance), and physical activity (survey, actigraphy) of residents; Aim 2. Evaluate the impact of FBFC-CI on adverse events (falls, emergency room admissions and hospitalizations); and Aim 3. Demonstrate staff adoption and maintenance of use of FBFC approaches. Residents will have moderate to severe cognitive impairment (MMSE d 15) and data will be collected at baseline, 4, and 12 months. This study will be a critical next step in delineating how to change care approaches provided to residents with moderate to severe dementia so as to decrease behavioral symptoms, optimize function and physical activity and decrease inappropriate psychotropic medication use and adverse event experienced by these individuals.